Zhu Ying, Zhou Wei, Jia Xiao-Hong, Huang Ou, Zhan Wei-Wei
Department of Ultrasound, Shanghai Ruijin Hospital, affiliated with the Medical School of Shanghai Jiaotong University, Shanghai, China.
Comprehensive Breast Health Center, Shanghai Ruijin Hospital, affiliated with the Medical School of Shanghai Jiaotong University, Shanghai, China.
J Ultrasound Med. 2018 Jun;37(6):1357-1365. doi: 10.1002/jum.14545. Epub 2018 Feb 9.
To determine whether imaging and clinicopathologic features could predict false-positive axillary ultrasound (US) results in the selection of patients with breast cancer who had a heavy axillary tumor burden (≥3 tumor-involved nodes).
Among 788 patients with histologically confirmed invasive breast cancer at Ruijin Hospital from October 2014 to September 2015, 162 patients (cT1-T2, cN0) with 167 axillae had suspicious axillary US findings. Ultrasound findings were considered suspicious for metastasis if cortical thickening of greater than 3 mm or effacement of the fatty hilum was present. The false-positive rate of suspicious axillary US results for identifying 3 or more positive lymph nodes in the final pathologic examination was calculated. Univariate and multivariate analyses were used to evaluate imaging and clinicopathologic factors related to the false-positive results.
Axillary US showed a false-positive rate of 60.5% (101 of 167) in the patients with breast cancer and a heavy nodal burden. By logistic regression analyses, we found false-positive axillary US results more frequently in patients who had a T1 stage tumor (P = .005), an estrogen receptor/progesterone receptor-negative tumor (P < .001), solitary suspicious nodes identified on axillary US (P < .001), and a cortical thickness of the most suspicious lymph node of 3.5 mm or less (P = .015).
Imaging and clinicopathologic features can be used to identify axillae with less than 3 metastatic nodes in patients with early-stage breast cancer who have positive axillary US results. In the post-American College of Surgeons Oncology Group Z0011 trial era, conducting a secondary evaluation either clinically or by axillary imaging before the use of a US-guided biopsy of suspicious nodes can potentially avoid the additional morbidity of axillary lymph node dissection and reduce the preoperative workload.
确定在选择腋窝肿瘤负荷重（≥3个受累淋巴结）的乳腺癌患者时，影像学和临床病理特征能否预测腋窝超声（US）检查结果为假阳性。
2014年10月至2015年9月在瑞金医院788例经组织学确诊的浸润性乳腺癌患者中，162例（cT1-T2，cN0）共167侧腋窝有可疑腋窝超声表现。如果出现皮质增厚大于3mm或脂肪门消失，则超声表现被认为可疑为转移。计算最终病理检查中可疑腋窝超声结果对识别3个或更多阳性淋巴结的假阳性率。采用单因素和多因素分析评估与假阳性结果相关的影像学和临床病理因素。
乳腺癌且淋巴结负荷重的患者中，腋窝超声的假阳性率为60.5%（167例中的101例）。通过逻辑回归分析，我们发现T1期肿瘤患者（P = 0.005）、雌激素受体/孕激素受体阴性肿瘤患者（P < 0.001）、腋窝超声发现孤立可疑淋巴结的患者（P < 0.001）以及最可疑淋巴结皮质厚度为3.5mm或更小的患者（P = 0.015），腋窝超声结果假阳性更为常见。
影像学和临床病理特征可用于识别腋窝超声结果阳性的早期乳腺癌患者中转移淋巴结少于3个的腋窝。在美国外科医师学会肿瘤学组Z0011试验后的时代，在对可疑淋巴结进行超声引导活检之前，通过临床或腋窝影像学进行二次评估可能避免腋窝淋巴结清扫带来的额外发病率，并减少术前工作量。
